Healthcare Provider Details

I. General information

NPI: 1447328000
Provider Name (Legal Business Name): ANDREW L. MOLTENI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 FRANKLIN STREET SUITE 1
SARATOGA SPRINGS NY
12866-3065
US

IV. Provider business mailing address

63 FRANKLIN STREET SUITE 1
SARATOGA SPRINGS NY
12866-3065
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-0499
  • Fax: 518-587-0536
Mailing address:
  • Phone: 518-587-0499
  • Fax: 518-587-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8987-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8987-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number8987-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number8987-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number8987-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number8987-1
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8987-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: